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Altra BSN, RN

Emergency & Trauma/Adult ICU
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Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

༄�Proud member of the Crusty Old Bat Society�༄

Altra's Latest Activity

  1. Altra

    My thoughts. Literally. Catheter. Psych Pt. ED

    This thread is about treatment of suicidal patients in the ED. Not the woulda-coulda-shoulda that may or may not have occurred prior to the patient arriving in the ED, or the various modalities of mental health treatment across the entire spectrum of care ... just what happens once a patient presents to the ED expressing suicidality or at risk. The baseline expectation is safety of the patient. Procedures are designed to maintain the physical safety of the patient, to allow for evaluation of what the best next steps are.
  2. Altra

    My thoughts. Literally. Catheter. Psych Pt. ED

    I was talking about standard non-slip "hospital socks". No one walks around a hospital barefoot, for numerous reasons related to safety and hygiene.
  3. Secretaries run the unit logistics. Yes, you as a nurse are focused on the clinical care of your patients, but all that logistical stuff in the background enables you to do that. In my experience, it's common for newer nurses to be pretty unaware of the organizational/logistical grease that makes the wheels spin ... and so we have "conflicts" such as the OP describes. Consider the posts in this thread from those who work without ancillary help -- then reconsider how you can better work with them.
  4. Altra

    My thoughts. Literally. Catheter. Psych Pt. ED

    Thank you, especially for the part I have bolded. The patient was poorly handled from the beginning -- Not being directed to an appropriate room, creating the situation that he needed to walk from point A to point B clad in only a hospital gown Being given an inappropriately sized gown -- if you grab the wrong gown by mistake, how much effort does it take to say, "oops - hang on - let me get another one"? And why no second gown to cover the back ... or scrub/pajama pants? Why no socks? Since when do we allow any hospital patient to walk around barefoot? Still too busy admiring the patient's feet? Yes, a urine specimen is required for a UDS, as well as either a breathalyzer or blood ETOH level. But this could have been handled so much better. And BTW - OP has provided no evidence that any catheterization was performed -- only that she perceives that "girls at the desk" were talking about it. When it was time for the patient to be transported to the inpatient facility, supposedly he was handcuffed. This would be a violation of health department regulations and most EMS agency policies. I have treated and admitted many psych patients -- none have been restrained except temporarily during an episode of violent behavior. In short ... I'm not buying it. The only thing I am convinced of from the OP -- is that her own practice with the patient was poor to say the least. If the OP was written as some kind of catharsis -- it would be nice to see some recognition of this, and some resolve to improve.
  5. Altra

    I'm about ready to quit!!

    What about exploring being a medication aide, if you're in a state where those are utilized in LTCs, assisted living, or home settings? Or an aide to a medically-fragile child who attends school? Best of luck to you, that you find something that is less physically demanding. Don't give up, unless your condition qualifies you for disability, or you can afford the loss of your income.
  6. Altra

    Online vs Face-to-Face RN-to-BSN Programs

    I live in a large metropolitan area, with several colleges/universities, all but one of which offer RN-BSN either online, in the classroom, or both. For schools which offer both, there is no variation between the online and classroom-based curricula. Are you sure that you're not comparing a college/university's pre-licensure program to their online RN-BSN completion program? The pre-licensure program is of course going to have to include formal pathophys and pharmacology as it will be students' first exposure. But many programs work this content into courses that are given a more broad title.
  7. Altra

    No pain meds in ER??

    Most of this entire thread is extremely disappointing. Hearsay ... hyperbole ... and very incomplete understanding. No one is "outlawing" anything. No meds are being "pulled" from St. Joseph's (the hospital in question) or any other ER. This is not an ER in which there are "no pain meds", as suggested by the thread title. As crisis rages, hospital works to reduce opioids in the ER St. Joseph's ER (one of the busiest ERs in the country) is rethinking its pain management protocols, with the goal of reducing opiate use. This is specifically for ER care, for patients who do not already have a condition requiring opiate pain management. And to the poster who commented that ER patients are not surveyed -- that is not an accurate statement.
  8. Altra

    Ideas for employee engagement

    What is your "High 5" program and what recognition and/or incentives does it involve? What engagement "behaviors" specifically are you looking to elicit?
  9. Altra

    My thoughts. Literally. Catheter. Psych Pt. ED

    I'm going to guess that you are a very new nurse, and very new to the ED. Please discuss with your preceptor, immediately: 1. Why do we insist that those who present with suicidal or homicidal ideation remove all clothing? Hint: it's not about the patient harming him/herself with underwear - it's about what objects can be hidden in clothing that most definitely can harm the patient, you, and anyone else. And do not underestimate the usefulness of seemingly innocuous objects, including underwear, to someone who unfortunately is motivated to do harm. 2. Educational resources for you to review to familiarize yourself with common responses to trauma and stress, and the common sequelae to these destabilizing events. That you appear to have some empathy is positive, but you have an immediate need to develop better boundaries so that you can manage the situation clinically, which is your job. 3. We are all human, and yes we notice where an individual patient falls on the spectrum of features that we personally find attractive. But if you are properly focused on the clinical situation, that notice lasts for approximately 2 seconds. Dwelling on it for any longer than that ... means that your attention is not where it should be. 4. How can you better prepare for your next patient with a psychiatric complaint? What supplies should you gather at the outset - appropriate-sized gown, socks, scrub/pajama pants, urine cup for specimen, etc. - to streamline the process?
  10. Altra

    How to Decide

    I agree with Pixie.RN's post -- 200 patients/day in just 14 beds? But putting that aside ... if you are committed to relocation, take the community hospital job.
  11. Altra

    Multiple gtts

    Hopefully your order sets will include titration parameters such as frequency and increment - these are a good starting point. Management of multiple vasoactive gtts requires a solid knowledge of the drugs' pharmacology and your patient's particular patho. Make use of all of your resources during orientation - your preceptor, other nurses, physicians, respiratory therapists, and physicians ... and your hospital's clinical references. Enjoy the learning!
  12. Altra

    How to think like and ER nurse

    A million likes for this excellent post!
  13. Altra

    need help w a short and long term goal

    Some food for thought: think carefully about cause and effect -- if I (patient) do not speak to you, one particular nursing student, does this mean I am developmentally delayed? Try searching your resources for care planning appropriate to a total care patient. What kinds of things do we do for non-ambulatory patients, or patients who cannot perform their own hygiene or other ADL? Then focus on the goals of these interventions, and what evidence would demonstrate the effectiveness of these nursing measures.
  14. I can understand where you're coming from, as can anyone who has worked in more than one hospital. You learn the "right way" and then go somewhere else where things are done differently - it can set off alarm bells. As for the specific situations you mentioned: 1. Terrible practice, that tends to develop when physicians are allowed to pawn off responsibility for obtaining consent onto busy nurses. But just for some perspective -- the alert & oriented patient could certainly have physically refused the transfusion, or any other care. I'm not excusing it -- just food for thought. You will not be able to single-handedly change this culture, but you can speak to a trusted charge nurse or your manager to see if they are open to initiating some conversations with physicians to obtain their own freaking consent, as they should be. 2. Hard to comment on this one without knowing the patient's situation and understanding the organizational relationship between the LTC and the rest of the hospital. As ED nurses we have to remember that things work differently outside of the ED setting -- ordered tests/procedures sometimes take days to complete. I will say that in all EDs in which I've worked, we sometimes get LTC/SNF patients for outpatient testing or procedures that they were otherwise unable to obtain for the patient. Is it right or an appropriate use of resources? No. Is it sometimes necessary to care for the patient? Yes. 3. So your dirty utility room is a pigstye. Unfortunate, but not something I'd be raising alarm bells about. Just because POC tests are left sitting there, doesn't necessarily mean you can conclude that no one resulted them at the appropriate time. They just couldn't be bothered to clean up afterward. 4. I have "miraculously" remembered what meds I need to obtain/give to my patients my whole career. I verify the patient's identity/armband per hospital policy. But if you prefer to print out orders (or utilize a COW), by all means, have at it. Hope that you settle in to your new department - transition is always hard!
  15. Altra

    Patient education and documentation.

    I'll address your fundamental question -- no, I do not think you should enter new documentation on all the patients you've discharged in the last few months. That pattern of late documentation would appear highly questionable. If you believe you also failed to document anticoagulation education on other patients, relay this information to your manager and ask for direction.
  16. Altra

    Tag team elopement

    Several things stand out to me about this scenario. 1. Have you all had some type of non-violent crisis intervention training, such as CPI? Reading of staff running after patients, getting in between patient and other staff ... I'm not seeing evidence of appropriate training. 2. If there is some procedure to remove patient belongings ... there is some procedure with criteria for returning them. 3. Speaking of procedures -- what was the admitting dx that required an ambulatory patient at high risk of flight to have a peripheral IV? I'm glad to hear that there will be a (hopefully thorough) root cause analysis of this event -- there is much to improve.
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